Del E. Webb Family Enrichment Center Waitlist Form

Del E. Webb Family Enrichment Center Waitlist Form

Complete this form to be placed on the waitlist for childcare.
How to complete this form
1. Fill out the Parent / Guardian 1 section. If you have an additional parent / guardian, complete Parent / Guardian 2 section.
2. Fill out the Child 1 section. If you have any additional children, fill out the additional child sections.
3. Once you submit the form, you will be notified when a spot becomes available by phone and email. Please respond within 48 hours.
If you have any questions, please call (928)776-2111.

Parent / Guardian First Name (1)
Parent / Guardian Last Name (1)
Address - Parent / Guardian (1)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email - Parent / Guardian (1)
Contact Phone - Parent / Guardian (1)
Please enter a valid phone number.Format: (000) 000-0000.
Re-order this list based on your preferred schedule. (Drag and drop blocks)
Choose your enrollment status
You can determine if you may qualify for the PELL Grant by creating an estimate of how much federal student aid you may be eligible for at https://studentaid.gov/aid-estimator/
Are you eligible for the PELL Grant?
Number of credit hours being taken this semester
Are you an employee at Yavapai College
What is your job title at Yavapai College
Are you an employee of a local, county, regional, state, or federal public organization/government agency?
Please enter your agency name and job title
Currently receiving Arizona Department of Economic Security (DES) Childcare Assistance
Currently receiving TANF, DES cash assistance, or WIC
Federal Poverty Level (FPL)

Federal Poverty Level Chart by family size and income percentage thresholds.
Family Size	100%^{^}	150%*	165%^{^}	300%*
1	$16,067.00	$23,940.00	$26,520.00	$47,880.00
2	$21,706.00	$32,460.00	$35,816.00	$64,920.00
3	$27,345.00	$40,980.00	$45,123.00	$81,960.00
4	$32,996.00	$49,500.00	$54,444.00	$99,000.00
5	$38,635.00	$58,020.00	$63,752.00	$116,040.00
6	$44,274.00	$66,540.00	$73,059.00	$133,080.00
7	$49,925.00	$75,060.00	$82,380.00	$150,120.00
8	$55,564.00	$83,580.00	$91,687.00	$167,160.00
9	$61,203.00	$92,100.00	$100,995.00	$184,200.00
10	$66,854.00	$100,620.00	$110,316.00	$201,240.00
11	$72,493.00	$109,140.00	$119,623.00	$218,280.00
12	$78,132.00	$117,660.00	$128,919.00	$235,320.00

* FPL supplied by the U.S. Department of Health & Human Services.

^ FPL supplied by FEC.

Parent / Guardian First Name (2)
Parent / Guardian Last Name (2)
Address - Parent / Guardian (2)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email - Parent / Guardian (2)
example@example.com
Contact Phone - Parent / Guardian (2)
Please enter a valid phone number.Format: (000) 000-0000.
Choose your enrollment status (2)
You can determine if you may qualify for the PELL Grant by creating an estimate of how much federal student aid you may be eligible for at https://studentaid.gov/aid-estimator/
Are you qualified for the PELL Grant (2)?
Number of credit hours being taken this semester (2)
Are you an employee of The College (2)
What is your job title at The College
Are you an employee of a local, county, regional, state, or federal public organization/government agency?
Please enter your agency name and job title
Currently receiving Arizona Department of Economic Security (DES) Childcare Assistance
Currently receiving TANF, DES cash assistance, or WIC
Federal Poverty Level (FPL)

Federal Poverty Level Chart by family size and income percentage thresholds.
Family Size	100%^{^}	150%*	165%^{^}	300%*
1	$16,067.00	$23,940.00	$26,520.00	$47,880.00
2	$21,706.00	$32,460.00	$35,816.00	$64,920.00
3	$27,345.00	$40,980.00	$45,123.00	$81,960.00
4	$32,996.00	$49,500.00	$54,444.00	$99,000.00
5	$38,635.00	$58,020.00	$63,752.00	$116,040.00
6	$44,274.00	$66,540.00	$73,059.00	$133,080.00
7	$49,925.00	$75,060.00	$82,380.00	$150,120.00
8	$55,564.00	$83,580.00	$91,687.00	$167,160.00
9	$61,203.00	$92,100.00	$100,995.00	$184,200.00
10	$66,854.00	$100,620.00	$110,316.00	$201,240.00
11	$72,493.00	$109,140.00	$119,623.00	$218,280.00
12	$78,132.00	$117,660.00	$128,919.00	$235,320.00

* FPL supplied by the U.S. Department of Health & Human Services.

^ FPL supplied by FEC.